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Anesthetic and Obstetric Considerations in a 32yo with Epidemic Kaposi's Sarcoma
Abstract Number: SUN-66
Abstract Type: Case Report/Case Series
Kaposi’s sarcoma (KS) is an opportunistic proliferative tumor that develops with increased frequency after human immunodeficiency virus (HIV) infection. KS is rare in women and even rarer in pregnancy secondary to human chorionic gonadotropin-like hormone causing apoptosis in KS cells (1). When present in women, the disease process is more aggressive with lesions present in the pulmonary and gastrointestinal systems as well as mucous membranes and along the vascular endothelium. With the rare occurrence of KS in pregnant women, it is questionable to which type of anesthesia provides the optimal safety and efficacy. We present a 32yo G3P2002 at 37 wks with AIDS and “undiagnosed KS” that presented for urgent cesarean section (CS) secondary to premature rupture of membranes with a high viral load. The patient was diagnosed with HIV in 2010, but was non-compliant with highly active antiretroviral therapy (HAART) with resulting labs: CD4 count 13mcl and viral load 4012 copies/mL. Comorbidities also included HIV dementia and bipolar disorder that made healthcare goals a challenge. Upon arrival to the operating room, multiple disseminated cutaneous lesions were discovered on the patient’s trunk, arms, legs, and back of unknown origin. The patient had no previous diagnosis of KS, but given the poorly controlled AIDS history, the lesions were clinically diagnosed as Kaposi’s nodules. Spinal anesthesia was performed where there were no visible lesions. The subcutaneous or non-visible lesions were our main concern when performing a spinal that could potentially cause neuraxial hematoma formation and/or extension of HIV/KS into the central nervous system. Previous literature supports neuraxial anesthesia in HIV parturients with no increased infection rates or neurological sequalea, but these studies include a majority of patients with HIV and CD4 counts >200, unlike our patient scenario (2). Fortunately, a T4 level with spinal anesthesia was obtained and an uneventful CS occurred with delivery of a male infant with Apgars 7 and 9. We will discuss risks that accompany both general and neuraxial anesthesia in KS patients, obstetric concerns that result in maternal and fetal morbidity, and highlight the affects of HAART therapy in HIV parturients and neonates in the peripartum period. Ultimately, the infectious disease team clinically diagnosed the patient with epidemic KS given the patients AIDS status and characteristic KS lesions. No adverse neurologic outcomes were observed and the patient and baby were discharged after a 5-day hospital stay.
1. Goedert JJ, Charurat M, Blattner WA. “Risk factors for Kaposi’s sarcoma-associated
herpes virus infection amongst HIV-1 infected pregnant women in the USA.” AIDS. 2003;17(3):425–433
2. Gershon R, Williams D. "Anesthesia and the HIV infected parturient: a retrospective
study." International journal of obstetric anesthesia 6.2 (1997): 76-81.